The mobility of our joints, the ability of them to move for greater or lesser amounts from fully bent to fully extended, is very variable. Some people are very stiff jointed while others are very mobile, with familial tendencies being important, so our joint mobility can be closely related to our parents. Many diagnostic names have been attached to conditions where hypermobility is important, including joint laxity, double jointed, loose jointed, ligamentous laxity and benign joint hypermobility syndrome.
The assessment of hypermobility is typically clinical in terms of the doctor or therapist examining and testing the patient. Various testing systems have been proposed over the years, with the Beighton test being a typical measure involving:
It is possible to pull the fifth finger up and beyond 90 degrees to the back of the hand. If this is possible then a score of one is given for that, with two if both fingers show the mobility.
The thumb can be pushed back until it lies along the underneath surface of the forearm. The points are the same as above.
Elbow extension continues more than ten degrees beyond straight.
Knee extension continues more than ten degrees beyond straight.
With the knees straight the patient is able to flex over frontwards and place the palms of the hands on the ground.
Nine is the maximum score in this test if the person exhibits two points for all the peripheral joint tests and can accomplish the last also. A typical score of 6 of 9 is suggested for a diagnosis of hypermobility.
About four to seven percent of the overall population could be said to be hypermobile, although there may be higher levels of joint laxity in gymnasts and dancers. There appear to be many bodily aspects which affect the likelihood of having lax joints and these may include the structure of the joints, the tone of the muscles and the connective tissue structures such as ligaments and tendons.
The mechanical properties of the connective tissues which make up joints appear to be the most important aspect of joint mobility. Collagen is the tissue which makes up significant amounts of our bodies, being found in skin, discs, tendons, ligaments and other tissues. Variations in the structure and function of collagen are the explanation for variations in joint laxity. Genetic variations in the synthesis of collagen can allow for weakened or lengthened soft tissues.
Hypermobility is very variable amongst individuals and the consequences can vary themselves, from nothing or very minor problems to chronic pain and disabling symptoms. Typical symptoms which may occur in people with hypermobility are joint pain, loss of accurate joint position sense, increased risk of trauma to joints, increased risk of dislocations, joint swelling and osteoarthritis. Simple activities such as maintaining posture, walking, dancing or taking exercise can be challenging.
A specialist doctor should perform the initial assessment and testing of the patient for a secure and accurate diagnosis, with a physical and treatment assessment by an experienced physiotherapist. The presenting symptoms and potential management of hypermobility can be so varied that careful attention is needed. Patient education is a key priority to identify the overall benign form of the condition and identify the consequences and potential treatments. Joint protection should be taught for stressful activities.
Some sports and occupations may be unsuitable such as contact sports or jobs which involve strenuous work, momentum or joint stresses. Joint protection principles should be taught and encouragement of an appropriate exercise regime. Moderate exercise can be useful to control weight, encourage good posture and train good muscular joint support. Manual therapy techniques can be used, along with hydrotherapy, acupuncture, TENS (transcutaneous electrical nerve stimulation) and other techniques.
Drugs need to be carefully considered by a doctor due to the potential side effects with long term use and the complexity of some pain medications. Severe joint damage or arthritis can be managed by surgical care such as fusion or replacement of the damaged joints. There are a number of medical conditions which have hypermobility as part of their symptom presentation. Ehlers-Danloss Syndrome type three is thought to be synonymous with joint hypermobility of benign cause. - 14130
The assessment of hypermobility is typically clinical in terms of the doctor or therapist examining and testing the patient. Various testing systems have been proposed over the years, with the Beighton test being a typical measure involving:
It is possible to pull the fifth finger up and beyond 90 degrees to the back of the hand. If this is possible then a score of one is given for that, with two if both fingers show the mobility.
The thumb can be pushed back until it lies along the underneath surface of the forearm. The points are the same as above.
Elbow extension continues more than ten degrees beyond straight.
Knee extension continues more than ten degrees beyond straight.
With the knees straight the patient is able to flex over frontwards and place the palms of the hands on the ground.
Nine is the maximum score in this test if the person exhibits two points for all the peripheral joint tests and can accomplish the last also. A typical score of 6 of 9 is suggested for a diagnosis of hypermobility.
About four to seven percent of the overall population could be said to be hypermobile, although there may be higher levels of joint laxity in gymnasts and dancers. There appear to be many bodily aspects which affect the likelihood of having lax joints and these may include the structure of the joints, the tone of the muscles and the connective tissue structures such as ligaments and tendons.
The mechanical properties of the connective tissues which make up joints appear to be the most important aspect of joint mobility. Collagen is the tissue which makes up significant amounts of our bodies, being found in skin, discs, tendons, ligaments and other tissues. Variations in the structure and function of collagen are the explanation for variations in joint laxity. Genetic variations in the synthesis of collagen can allow for weakened or lengthened soft tissues.
Hypermobility is very variable amongst individuals and the consequences can vary themselves, from nothing or very minor problems to chronic pain and disabling symptoms. Typical symptoms which may occur in people with hypermobility are joint pain, loss of accurate joint position sense, increased risk of trauma to joints, increased risk of dislocations, joint swelling and osteoarthritis. Simple activities such as maintaining posture, walking, dancing or taking exercise can be challenging.
A specialist doctor should perform the initial assessment and testing of the patient for a secure and accurate diagnosis, with a physical and treatment assessment by an experienced physiotherapist. The presenting symptoms and potential management of hypermobility can be so varied that careful attention is needed. Patient education is a key priority to identify the overall benign form of the condition and identify the consequences and potential treatments. Joint protection should be taught for stressful activities.
Some sports and occupations may be unsuitable such as contact sports or jobs which involve strenuous work, momentum or joint stresses. Joint protection principles should be taught and encouragement of an appropriate exercise regime. Moderate exercise can be useful to control weight, encourage good posture and train good muscular joint support. Manual therapy techniques can be used, along with hydrotherapy, acupuncture, TENS (transcutaneous electrical nerve stimulation) and other techniques.
Drugs need to be carefully considered by a doctor due to the potential side effects with long term use and the complexity of some pain medications. Severe joint damage or arthritis can be managed by surgical care such as fusion or replacement of the damaged joints. There are a number of medical conditions which have hypermobility as part of their symptom presentation. Ehlers-Danloss Syndrome type three is thought to be synonymous with joint hypermobility of benign cause. - 14130
About the Author:
Jonathan Blood Smyth is the Superintendent of Physiotherapists at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for Physiotherapists in Bournemouth visit his website.
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